Daniel J. Hogan, MD
What are the efficacy and harms of topical interventions for treatment of genital lichen sclerosus (LS)?
Included studies evaluated topical interventions for treatment of genital LS diagnosed by a medical practitioner. Outcomes were patient-rated symptom improvement or remission, investigator-rated global disease improvement, and adverse drug reactions (ADRs).
MEDLINE (from 2005), EMBASE/Excerpta Medica (from 2007), Cochrane Skin Group Specialized Register, Cochrane Central Register of Controlled Trials (including searches of MEDLINE to 2004 and EMBASE/Excerpta Medica to 2006), LILACS (from 1982), CINAHL (from 1981), British Nursing Index and Archive (from 1985), Science Citation Index Expanded (from 1945), BIOSIS Previews (from 1926), Conference Papers Index (from 1982), Conference Proceedings Citation Index–Science (from 1990), and trial registries (metaRegister of controlled trials, ClinicalTrials.gov, World Health Organization International Clinical Trials Registry, Australian New Zealand Clinical Trials Registry, and Ongoing Skin Trials Register), all to Sep 2011; and reference lists were searched for randomized controlled trials (RCTs). 7 RCTs (n = 257, 2 to 30 patients/treatment group) met inclusion criteria and evaluated corticosteroids (clobetasol propionate or mometasone furoate), androgens (testosterone or dihydrotestosterone), progesterone, or an immunomodulator (pimecrolimus). 6 RCTs recruited only women (n = 217), and 1 recruited only boys (n = 40). 2 RCTs had adequate allocation concealment, 4 used blinding of patients and investigators, and 2 reported withdrawal and dropout rates.
The main findings for topical corticosteroids are in the Table. Topical testosterone (2 RCTs, n = 97), dihydrotestosterone (1 RCT, n = 5), and progesterone (1 RCT, n = 39) did not differ from placebo for any reported outcome at 3 months to 1 year; testosterone did not differ from dihydrotestosterone at 3 months (1 RCT, n = 5); and maintenance testosterone after clobetasol did not differ from placebo for severe ADRs at 24 weeks (1 RCT, n = 32).
Limited evidence suggests that topical clobetasol and mometasone are each effective for treatment of genital lichen sclerosus.
Topical interventions for treatment of genital lichen sclerosus*
*ADR = adverse drug reaction; SMD = standardized mean difference; other abbreviations defined in Glossary. RBI and CI calculated from risk ratios and CIs in article.
Hogan DJ. Review: Limited evidence suggests that clobetasol or mometasone is effective in genital lichen sclerosus. Ann Intern Med. ;156:JC5–10. doi: 10.7326/0003-4819-156-10-201205150-02010
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Published: Ann Intern Med. 2012;156(10):JC5-10.
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